Provider Demographics
NPI:1215534953
Name:SUSAN P DUNKO MS LPC LLC
Entity Type:Organization
Organization Name:SUSAN P DUNKO MS LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:860-341-2304
Mailing Address - Street 1:17 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 HICKORY HILL DR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:CT
Practice Address - Zip Code:06232-1013
Practice Address - Country:US
Practice Address - Phone:860-341-2304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1578891891OtherNPI